Histopathologic reaction patterns to differentially cross‐linked hyaluronic acid fillers: A retrospective case series

Abstract

Background Hyaluronic acid filler reactions have been increasingly observed in recent years. Our study investigates whether the increased number of filler reactions observed since 2014 is associated with a specific histopathologic inflammatory pattern and type of filler. Methods The institution's dermatopathology electronic database was retrospectively searched for histopathologic reactions to hyaluronic acid from January 2014 to December 2019. The age, sex, type of filler, procedure, location, and histopathologic patterns were recorded. Results From 2014 to 2019, there were 15 cases of granulomatous reactions to hyaluronic acid filler. In 10 of these cases, there was a characteristic inflammatory pattern characterized by tightly cuffed palisades of histiocytes with varying numbers of eosinophils. Of the 11 cases in which the type of filler was known, all used Vycross technology, a novel manufacturing process in the production of hyaluronic acid filler. Conclusion A characteristic histopathologic pattern of discrete foci of tightly cuffed palisaded granulomas with eosinophils is associated with fillers manufactured using Vycross technology.

Persistent Nose Swelling in a Teenage Girl: Answer

“…1,6 Suppurative granulomas, with negative tissue cultures, have also been described. 2 The hyaluronic acid filler stains positively with colloidal iron and Alcian blue at a pH of 2.5, but it shows negative result for periodic acid–Schiff stain and shows no birefringence under polarized light. 7…”

“…1 Although rare, delayed-onset hypersensitivity reactions are being reported increasingly often, especially with newly developed products. 2 The diagnosis can be challenging by the patient's reticence to give a proper clinical history. Clinically, delayed-onset hypersensitivity reactions are characterized by the occurrence of persistent indurated erythematous papules and nodules, appearing weeks to months after the injections.…”

“…1,6 Suppurative granulomas, with negative tissue cultures, have also been described. 2 The hyaluronic acid filler stains positively with colloidal iron and Alcian blue at a pH of 2.5, but it shows negative result for periodic acid-Schiff stain and shows no birefringence under polarized light. 7 Differential diagnosis may include lupus pernio, extranodal natural killer/T-cell lymphoma, nasal type and lupus vulgaris, and other dermal fillers, such as polyacrylamide hydrogel and polyalkylimide gel.…”

Are Delayed Dermal Filler Granulomas More Common Since COVID-19?

“…Delayed HA granulomas have a variety of causes. 1 , 2 , 3 , 4 , 5 , 6 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 17 , 18 , 19 , 20 , 21 , 22 , 24 Anecdotal evidence brought a new concern with the COVID pandemic – the effect of COVID infection or vaccination on the development of granulomas. This retrospective cohort of the senior author’s practice shows that there was a statistical increase in the development of HA granulomas during the COVID pandemic.…”

“…Both chemicals are pro-inflammatory and may be related to late granuloma formation. 18 Infectious granulomas are caused by Staphylococcus aureus, Psuedomonas aeruginosa, mycobacterium abscessus, and Streptococcus spp. 4 , 19 Noninfectious granulomas are T lymphocyte cell mediated and associated with human leukocyte antigen types B*08 and DRB*03.…”